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About the Role

The Patient Access Cancer Services Representative is responsible for securing timely authorization of elective and emergent services, cooperating cross-departmentally and with physician offices to aid in completeness of pre-certification, aiding in proper reimbursement, and providing high-quality customer service to patients and colleagues. This position is responsible for maintaining and improving patient experience and keeping abreast of current insurance regulations. The role handles administrative support functions for Patient Access Services and collaborates with various staff to ensure regulatory and contractual mandate adherence.

Responsibilities

• Performs scheduling/registration functions and general office duties including word processing, copying, filing, faxing, answering phones and data entry.
• Verifies insurance eligibility of all insured and self-pay patients.
• Obtains and verifies authorization/notification for elective and emergent services via insurance payer website, facsimile, or phone.
• Reviews, assesses, and evaluates patient registrations to ensure accuracy of demographic and financial information.
• Responsible for maintaining add-on authorization and eligibility services.
• Stays abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.
• Collaborates with physician offices and third-party payers concerning authorizations and eligibility.
• Verifies co-payment, deductible, co-insurance, & out-of-network amounts according to patient’s health insurance plan and contractual agreement.
• Refers self-pay patients to financial aid/self-pay representative.
• Demonstrates advanced critical thinking skills and the ability to effectively navigate ambiguous patient scenarios.
• Maintains data integrity of various tracking spreadsheets.
• Manages the completion of monthly ERMA forms for Emergency Medicaid patients.
• Maintains current knowledge base regarding insurance information and managed care guidelines; maintains knowledge base of designated networks based upon managed care contracts.
• Collaborates with other departments to ensure the needs of the patient and department are met.
• Demonstrates ability to utilize data retrieval insurance eligibility systems.
• Develops and maintains positive customer service with all patients, colleagues, visitors and vendors by exercising the utmost diplomacy and tact.
• Manages RQA reports by resolving errors and producing corrected accounts.
• Abides by documentation guidelines consistently.
• Adheres to all company and department policies and procedures in confidentiality, regulatory or contractual mandates and HR policy.
• Practices confidentiality and privacy protocols in accordance with hospital policies and HIPAA requirements.
• Complies with departmental dress code and maintains a neat appearance.
• Keeps current with departmental and hospital training requirements, including the completion of annual refresher courses.
• Performs other department specific duties as deemed appropriate by Patient Access Leadership.

Requirements

• High School Diploma/GED and two (2) years’ experience in Revenue Cycle, or Medical Office, or Business office.
• One (1) year direct Patient Access experience.
• One (1) year direct insurance verification/authorization experience.
• Customer service and support skills.
• Quantitative/analytical skills and computer savviness including Microsoft Office, Word, Excel, and PowerPoint, including knowledge of external provider web portals.
• Demonstrates exceptional attention to detail and accuracy in all tasks, ensuring high-quality results and minimizing errors.
• Must be able to multitask in high stress fast-paced environment.
• Capable of working independently with minimal supervision, demonstrating strong self-motivation and initiative with strong time management skills to meet deadlines.
• Must possess comprehensive knowledge to help in assisting patient in understanding medical insurance benefits.
• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Southampton Hospital’s Employee Health Services.
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4 panel drug screen.
• Meet Regulatory Requirements for pre-employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s).

Skills

• Microsoft Office
• Word
• Excel
• PowerPoint
• External provider web portals
• CPT
• ICD-10
• Medical terminology

Location

• Southampton

Work Type

• Onsite
• Full-time

Experience Level

• 2 years experience in Revenue Cycle, or Medical Office, or Business office
• 1 year direct Patient Access experience
• 1 year direct insurance verification/authorization experience

Education Level

• High School Diploma/GED
• Associate's degree

Benefits

• All employee benefits

About the Company

• Stony Brook Southampton Hospital as part of Stony Brook Medicine provides direct access to the highest level of academic-based medical care.
• The hospital provides healthcare services to a diverse community of year-round residents, second homeowners and vacationers.
• Stony Brook Southampton Hospital has been recognized as a Long Island Top Workplace by Newsday among large employers (defined as having 500+ employees).
• StaffCo is a Professional Employer Organization, commonly referred to as a PEO, duty organized and registered under the New York Professional Employer Organization Law.
• StaffCo is fully responsible for providing all payroll and human resource services, including the payment of wages, collecting and reporting payroll taxes and maintaining any and all employee benefits.
• Stony Brook Medicine is committed to excellence in diversity and the creation of an inclusive learning and working environment.
• Stony Brook Southampton Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.